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COMPLIANCE INFO_2004-2005
Environmental Health - Public
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EHD Program Facility Records by Street Name
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C
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COUNTRY CLUB
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2575
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2300 - Underground Storage Tank Program
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PR0231070
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COMPLIANCE INFO_2004-2005
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Last modified
1/30/2023 2:30:02 PM
Creation date
6/3/2020 9:43:34 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2004-2005
RECORD_ID
PR0231070
PE
2351
FACILITY_ID
FA0006439
FACILITY_NAME
COUNTRY CLUB MOBIL CIRCLE K
STREET_NUMBER
2575
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
CURRENT_STATUS
01
SITE_LOCATION
2575 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2351_PR0231070_2575 COUNTRY CLUB_2004-2005.tif
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EHD - Public
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BILL OF LADING <br /> 3909 Park Road, Suite D <br /> WIRONN EWAL SERVICES Benicia, CA 94510 <br /> GROUP (877)748-3040 <br /> Western Region <br /> DELIVERY DATE JOB _rzea <br /> SHIPPER/CUSTOMER POINT OF CONTACT <br /> \DDRESS° PHONE# <br /> ;ITY,STATE,ZIP <br /> ;.-111 C -1K1204 <br /> '.ARRIER/TRANSPORTER PHONE# <br /> j k <br /> :ONSIGNEE!FACIUTY POINT OF CONTACT <br /> 1DDRESS PHONE# <br /> kr'S�gzp AY �-,�a c: rd �.':s3C•'t i,}i?.-.{t-�:'_ <br /> s <br /> :17Y,STATE,ZIP <br /> }'H. Ie. .. <br /> 6: <br /> 3 <br /> ipecial Handling Instruction and Additional Information: <br /> }; g ,���t g{gxxrr��tt���� MON <br /> /� � _ <br /> a! FRPT d) -01 - `104 Pi1lAEff. OMS, A ON SOLD 1.30 1, 44 rl ryry{fi t� {�tC . _ y�,(�� a�`4 :ett11 �t.. ,J'�f �, X?Y [k`'.i: -.�r`4.(,r�i�� ty t=c x'�[ SN' <br /> - ii 3c r � �)t. }f, ....1:.x.. .70.+.,i�c,.�� S,5 w..2j.. .., ._ �a�,., _� Fps z N'SN' <br /> £t Vit. St §43!-'4§. 11175) t'r`. 11. MUM-! tf-CMA:?tf 4935 <br /> f <br /> t <br /> lacards Provided YES NO Emergency Phone#(077) 748-3040 <br /> SHIPPER'S CERTIFICATION:1 hereby declaredthat the contents of this consignment are fully and accurately described above by proper shipping name and are classified,padted; <br /> narked,and labeled,and are in all respects in proper condition for tfansport by highway,vessel,and rail according to applicable intemationat and national <br /> government regulations. <br /> SHIPPER)PRINT OR TYPE NAME SIGNATOR <br /> . -_ ; .:. � .__-, MONTH DAY YEAR <br /> K <br /> :CARRIER/TRANSPORTER)PRINT OR TYPENAME SIGNATURE Mourn DAY YEM <br /> K r X <br /> :/CONSIGNEE/FACIUTY)PRINT OR TYPE NAME - SIGNATURE; MONIH DA`s 3 4R <br /> ry X `' 3 k f y�� v.=2 Jr... ^- i t i{. !) <br /> V T t <br /> -orm#PSC-201-RV 6/04 1 , <br /> SHIPPER <br />
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